Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Henry Samson death at Sydney, Cape Breton County on April 30, 1971
Male Death Registration: Year: 1971 number: 3292
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003292
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Spring Garden Villa, Sydney,NS
3. PRINT NAME OF DECEASED Samson, Henry
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Louisdale, Rich. Co
9. DATE OF BIRTH 7 23, 1883
10. AGE in Years87 Months9 Days7 | hrs or mins
11. Trade or profession pentioner
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Virginie Samson
16. NAME of Father Thomas Samson
17. BIRTHPLACE Louisdale, Rich. Co
18. NAME of Mother Justine Martell
19. BIRTHPLACE Petit de Grat, Rich. Co
20. Signature of Informant Virginie Samson
address Louisdale, Rich. Co
Relationship to deceased wife
21. Place of burial Louisdale, NS
Date of burial May 2,1971
22. Undertaker Cornelus Boucher, Arichat, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 30, 1971
CAUSE OF DEATH
(a) Stroke, (Rt Hemiplegia)
(b) Arteriosclerosis with Cardiac Disease
(c)
other Senility
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